Uhcattestation form 2026

1. Click ‘Get Form’ to open the uhcattestation form in the editor.
2. In Part I, enter the employer name in the designated field. Specify the date of termination by filling in the blank provided.
3. Sign and date the section labeled 'Signature of Policyholder' to confirm your intent to terminate the existing policy.
4. Move to Part II for Certification of Plan Year Change. Again, input the employer name where indicated.
5. Fill in the new Plan Year effective date in the appropriate space.
6. The Plan Administrator must sign and date this section to certify that all necessary actions have been taken regarding the Plan Year change.

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